Safety and Feasibility of Transcatheter Pacing System Implantation Guided by Intracardiac Echocardiography

Background: The number of major complications with the transcatheter pacing system (TPS) is lower than that with conventional transvenous pacing systems; however, the incidence of cardiac perforation or effusion with TPS is higher. Fluoroscopy-guided TPS implantation with contrast media injection through the delivery catheter is recommended to understand anatomic features. For patients who cannot be injected with contrast media substances, TPS implantation guided by intracardiac echocardiography (ICE) is an alternative to ensure appropriate myocardial apposition. Objective: Evaluating the safety and feasibility of ICE-guided TPS implantation. Methods: All consecutive patients who underwent TPS implantation between September 2017 and February 2019 at our institution were included in the present analysis. Results: Of the 51 TPS implantations, 50 (98.0%) were successfully performed. Of these, 8 were guided by ICE, whereas the remaining 42 were not. Baseline patient and lesion characteristics were similar between the 2 groups. Additionally, there was no difference between these groups in terms of procedural and fluoroscopy time, and contrast agent volumes. No major complications were observed in the ICE group, whereas one (2.3%) major complication (one cardiac tamponade) occurred in the non-ICE group at 30 days post-implantation. (p=1.000). No ICE-related complications occurred. Conclusion: The present study demonstrates the safety and feasibility of ICE-guided TPS implantation. ICE-guided TPS may be useful for implantation on the septal aspect of the right ventricle.